Time ratio disparities among ED patients undergoing head CT

Area of Science:

• Emergency Medicine
• Radiology
• Health Equity

Background:

• Disparities in healthcare access and outcomes are a significant concern within emergency departments (EDs).
• Timeliness of diagnostic imaging, such as head computed tomography (CT), is crucial for effective emergency care.
• Understanding potential demographic and insurance-related disparities in ED head CT workflows is essential for improving patient care.

Purpose of the Study:

• To investigate disparities in emergency department (ED) head computed tomography (CT) completion times.
• To determine if the indication for head CT influences these disparities.
• To assess wait times across different patient demographics and insurance types.

Main Methods:

• Retrospective cohort study of over 45,000 non-contrast head CTs across four hospitals (January 2016 - September 2020).
• Analysis of key time intervals: ED length of stay (LOS), ED assessment, image acquisition, and image interpretation.
• Utilized time ratio (TR) to compare time intervals between patient groups.

Main Results:

• Female patients experienced longer ED LOS, assessment, and acquisition times (TR=1.012, 1.051, 1.018).
• Black patients faced significantly longer ED LOS, acquisition, and assessment times (TR=1.226, 1.349, 1.190).
• Patients with Medicare/Medicaid insurance had extended wait times across all intervals (TR>1, P<0.001), irrespective of CT indication.

Conclusions:

• Significant disparities in ED head CT wait times exist for Black patients and Medicare/Medicaid insurance holders.
• Female patients, particularly those with head pain, also experienced prolonged wait times.
• Addressing the root causes of these disparities is critical for ensuring equitable and timely access to emergency imaging.